8 Chapter 8 – Just-in-time: Delivery that is not just in case

McKinnie, K., Stiver, M., & Treboni, A.


The concept of “just-in-time” originated as a Toyota manufacturing practice in the early 1980s. While there is no clear consensus on what just in time manufacturing entails, the term is used to describe practices which help to minimize waste, enhance productivity, and allow for greater flexibility in equipment and staff deployment (Hallihan, Sackett, & Williams, 1997). The concept of just-in-time training (JiTT) is derived from Toyota’s manufacturing concept.  JiTT is a way to deliver information when it is needed while a task is being performed and not just in case it is needed. While JiTT may have originated within the manufacturing industry, this philosophy has since transcended into other industries, including health professions and education. With more than “2.5 quintillion bytes of data being created everyday, our increased access to data and its creation will continue to change not only the way we approach learning but the way we structure training as well” (Marr, 2018). In order to determine the true possibilities of JiTT, we must first determine what it is and the ways in which it is currently being used.

In this chapter we will explore the following:

  • Definitions of JiTT and where is is used today
  • Industry Use and Best Practices
    • Business and Manufacturing
    • Education
    • Healthcare
  • JiTT and Technology
  • Future Implications

Definition and similar terms

JiTT is “training [provided] at the time it is needed, rather than when a course is available to meet a need that may or may not arise” (Rushby, 2006, n.p.). While there is no set definition for JiTT, it does not have to be delivered in a high-tech way. JiTT is delivery mode agnostic and ranges from the markings and instructions on everyday products to more complex videos and QR code access symbols for using specific equipment in healthcare professions (Andriotis, 2018; Mimeo, 2018). Similar terms include: Decision Support Systems (DSS), Computerized Decision Support (CDS), electronic performance support systems (EPSS), situation-based aids, microlearning (wikipedia definition), and decision aids (Kapp & Defelice, 2018). For the purpose of this chapter, JiTT will be used to refer to all of these concepts.

Six Elements for implementing Just-in-time-training

  • Cultivate a culture focused on learning
  • Use responsive, and often mobile, technology
  • Create highly relevant content that is short and digestible
  • Focus on competency or learning gaps
  • Make the content easy to find and searchable
  • Create social learning interfaces and platforms to increase engagement

(Andriotis, 2018)

Where is just-in-time training used today?

Although the term “just-in-time training” may not be a word used in everyday conversation, there are JiTT resources that can be seen daily. Whether it’s the instructions provided at the self check-out in our local grocery stores or the step-by-step cooking instructions enclosed in the food we purchase, it could be argued that JiTT is already embedded in people’s lives and they fail to recognize it.


Review the four (4) Dialog Cards to view examples of how JiTT can be seen daily.

Industry use and best practices

Business and manufacturing

Initiated by Toyota in the 1950s, just-in-time manufacturing aimed to reduce waste and create a model for continuous improvement (Halihhan, et al., 1997). Just-in-time manufacturing has been found to “generate an indirect effect that works through improvement of manufacturing infrastructure by providing a set of targets and discipline for the organization” (Sakakibara, Flynn, Schroeder, & Morris, 1997, p. 1256). Essentially, just-in-time manufacturing made factories and the workforce more flexible and responsive, better aligned company and supplier needs, and reduced waste of product and time.

Over time, JiTT has been seen in use in other areas of business. By focusing on training at the time it is needed, businesses can reduce waste from over-training, or continuously retraining, individuals (Rushby, 2006). Reviewing training routinely can also help avoid duplicate training sessions and help companies ensure that the sessions and methods they are using are the most effective available.

While most businesses still maintain a printed (or electronic) handbook, companies have been moving towards other modes of training delivery as well.  Video can be used to create learning “through a window of cognitive engagement” (Marx & Frost, 1998). Video modules help to provide training that has clear context and provides tangible examples of common situations and expected employee responses. Breaking training into smaller parts can help managers customize a training program to address knowledge and skill gap areas for individual employees (Dickerson, Shinners, & Chappell, 2017). The returns for training that is interactive, engaging, and provided when it is needed are great; just-in-time models can reduce training requests while increasing overall productivity (Lanese & Nguyen, 2012).

Even more recently Deloitte has been able to leverage JiTT practices in their online training programs. By reducing the length and complexity of training modules, adopting gamification (dictionary definition) techniques, and providing both expected and unexpected rewards for completion, Deloitte has increased participation in their training by 37% (Meister, 2013).

Just-in-time isn’t just for employees–businesses are using JiTT to reduce personnel costs and guide consumers:


Of the industries this chapter is addressing, education has the least sophisticated and briefest historical use of just-in-time techniques. Education began to see adoption in the mid-to-late 1990s, but not as training for teachers. Just-in-time teaching has emerged as a method that supports a flipped classroom model (wikipedia page) for teaching (Novak, 2011).  Just-in-time teaching can provide lessons and assessments to students in advance of instruction, which allows the instructor to modify subsequent in-person lessons. This allows the instructor to better engage students and provide them with immediate feedback and correction (Simkins & Maier, 2004).

Chickering & Gamson’s Seven Principles of Good Practice in Undergraduate Education

Just-in-time teaching:
• encourages student-faculty contact
• encourages cooperation among students
• encourages active learning
• gives prompt feedback
• emphasizes time on task
• communicates high expectations
• respects diverse talents and ways of learning”

(Simkins & Maier, 2004, p. 446).

Other offshoots of just-in-time delivery have also been seen in education through the use of Twitter and other social media platforms. Educators can look to these platforms for ideas and lesson plans, and for JiTT. After the 2015 terrorist event in Paris, France a group formed to provide feedback and support for educators faced with discussing the situation with their students.  The Twitter tag “#educattentats” was used to bring together a global community in a moment of need and to address a very specific topic most teachers have not received extensive training on (Greenhalgh & Koehler, 2017). While interest and use peaked within the first three days and continued to wane after the first week, during the month following the attack in Paris nearly 3,600 individuals were recorded in the thread (Greenhalgh & Koehler, 2017, n.p.). Greenhalgh & Koehler (2017) believe the success of Twitter for this situation was related to three constructs, as it was “characterized by learning that is driven by teachers, supported by knowledge brokers and framed by flexible structures” (n.p.). Social Media will continue to be adapted for use, and provides important opportunities for engagement in professional development that is not time or space bound.

While gamification has helped the business industry increase participation in training, it has had even more substantial impacts in education. When gaming elements are introduced to learning or training, individuals can feel empowered to conquer problems, and to focus on the process of learning more than on a grade (Huang & Soman, 2013). For technology delivered JiTT, immediate feedback and rewards can also increase participants interests in continuing to engage with content. Focusing on content in smaller pieces can increase the likelihood that participants will find success early on, which will motivate them to continue to move through longer and more complex lessons (Huang & Soman, 2013, p. 11). Gamification cannot be used in every situation, but used wisely, it can have positive impacts for teachers and students. As Huang and Soman (2013) point out, you “cannot gamify good grades, but instead, can gamify the process for students to get good grades” (p. 15).

How does gamification work?

Gamification is an engagement technique which can be applied to learning in educational settings. Gamifying lessons can:

  • break complex material into smaller parts
  • ensure immediate success for students, to motivate them to continue to engage in lessons
  • offer immediate feedback and support during lessons
  • change focus from grades to learning, by allowing students to test out ideas (Huang & Soman, 2013)

Virtual reality can also be seen in use in just-in-time education. Virtual worlds like Second Life allow students to test out ideas in a less threatening environment (Kopp & Burkle, 2010). To address communication anxiety in college students, a virtual environment was created that allowed students to practice their presentations (North, Hill, Aikuhele, & North, 2008). North et al. (2008) found that students had increased confidence and decreased anxiety in the virtual world. As technology continues to adapt and enhance, it is likely that just-in-time techniques will continue to find a place in education.


It is unknown when JiTT entered healthcare. This may be in large part because there are 6,210 total hospitals in the United States

Internet symbol with growing vine
Click here to view Cleveland Clinic’s Showcase website

according to the American Hospital Association (AHA) each with their own internal processes and training methodologies (AHA, 2019). As an almost twenty-year training and development employee in community-based hospitals, the introduction of the intranet, an internal employee website, allowed access to resources more quickly. Educators would often refer employees to review online policies should they have questions before conducting a procedure or carry out an action. It could be argued that this is “just-in-time-training” because employees were to grab the information when they needed it. This instruction fits perfectly in the previous definition of JiTT described at the beginning of our chapter. However, this informal learning process did not allow for a convenient mode to retrieve the information because staff would have to leave their duties to gather what they needed on a desktop computer located in a different physical space. When mobile devices became available, organizational policy restricted staff from using their devices while providing patient care.  On Cleveland Clinics’ Center for Technology-Enhanced Knowledge and Instruction (cTEKI) website, you can see that they have created a more structured process for this informal learning method, which they call point-of-care learning (Showcase, n.d.). The site explains that seventy percent of what their employees need to know is learned on the job. Employees can efficiently retrieve this need to know information by scanning QR codes (dictionary definition) placed throughout the organization on pieces of equipment or at the bedside. The QR codes are scanned with a mobile device so employees can obtain the information when they need it.  Furthermore, the Cleveland Clinic technology group has determined a way to capture this learning by linking the QR code information to their learning management system thus adding the completion of the learning on the employee’s learning transcript.

To illustrate another example of JiTT in healthcare, here is a YouTube video educating patients on how to administer an EpiPen.


Recommending JiTT During Public Health Emergencies

It is federal agencies, like the Centers for Disease Control (CDC), that have been more vocal about their recommendations to use JiTT to enhance learning processes. In 2015, the CDC’s Applied Learning and Development team within the Division of State and Local Readiness of Centers for Disease Control and Prevention recommended the use of just-in-time-training templates (definition) that can readily be customized to address the deployment of training during public health emergencies. The CDC was challenged when addressing medical countermeasures during emergent situations to rapidly train staff and volunteers because of limited resources and evolving information (AJPH, 2018). The CDC was able to deploy these JiTT templates during two public emergencies. The first was during the Zika virus outbreak in 2016-2017 where they deployed a JiTT to prepare staff to work on a CDC task force. The second was a JiTT on the basics of working at a Point of Dispensing (POD) site, which is a federally instituted best practice model used to provide medications, vaccines or medical supplies to a large community in the event of a health emergency.

JiTT Evaluative Data in Healthcare

There is some suggested success of JiTT in healthcare shown in evaluative data. Using the previous example of the CDC health emergency JiTT templates for the CDC task force and POD sites, staff and volunteer surveys were conducted both before and after their implementation (AJPH, 2018). These surveys assessed the perceived ability for staff to perform the tasks connected with the learning objectives and the usefulness of training using a 5-point rating scale. The results showed an increase of 1.8 points from pre-training to post-training results. Data also suggests that JiTT in the medical field can account for positive cognitive retention for nursing education. A convenience sample consisting of registered nurses was used. The nurses were taught a new assessment technique for pediatric patients on asthma exacerbation severity called the LA Phonospirometry technique. A brief instructional video was given for the nurses to learn the technique. A checklist was then administered to demonstrate proficiency with a re-assessment given 4-6 months later. The results showed minimal knowledge loss of 18% from the first assessment from the second. There are outside variables that are unknown, such as the frequency this assessment technique is used by the nurses, but there does seem to be promising results of retention for the JiTT method from this study.

Just-in-time-training and technology

Electronic performance support systems (EPSS) are a typical way in technology that we see just in time training. Systems of this type are usually device-based that can be accessed during the task at hand. Details in EPSS are kept to a minimum, but students/learners still receive the need to know information to complete the task (Sleight, 1993). This information is accessed by the leaner at their time of need. An example of an electronic performance support system that everyone might use is an e-file tax software like Turbotax which was previously explained in our chapter.

Characteristics of an Electronic Performance Support System (EPSS)

Typical characteristics of an EPSS include:

  • Device-based
  • Provides access to specific information to perform the task at hand
  • Used on the job, or during a specific practice
  • When the information is accessed is defined by the student/learner
  • May reduce detailed training prior to performing the task

(Sleight, 1993)

Simply having access to an abundance of information does not ensure that one can make sense of the data and use it in any constructive way. Decision Support Systems (DSS) were defined by Alyoubi (2015) as, “popular tools that assist with decision making in an organization” (p.278). DSS applies a series of mathematical equations to quantifiable data to provide a framework of programmed responses that assist in better understanding not only the raw data, but how the user can make sense of it as well. (Alyoubi 2015).  In higher education, one example of DSS would be the dashboards that often support institutional data warehouses or student information systems. The number of students enrolled at the university is much more meaningful when key stakeholders are able to make sense of it as it relates to their roles and responsibilities.

Characteristics of Decision Support Systems (DSS)

  • Data Collection-there must be information
  • Data management-must be stored
  • Data analysis-helps to make sense to the user
  • Data Presentation-ensures information is usable

(Sudholz, 2016)

Future implications and closing

Despite humble beginnings in the manufacturing industry, JiTT has become so much more than a way to disseminate information. It has evolved into a philosophical lens that we now view teaching and learning in any setting. Technology has already had a huge impact on JiTT, and its presence is pervasive in our everyday lives. While initial forms of JiTT include handwritten and printed instructions for things as simple as cooking recipes or instructions, we now also see JiTT when we get a quick guide to software updates or watch a video to repair a broken item in our homes. With every iteration of more powerful internet and our increasing expectation for immediacy as it relates to information, JiTT will continue to be a staple in society.


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